Child Pugh Calculator

Child Pugh Calculator is a calculator used to give you a clue about the severity of the patient’s condition, prognosis, and mortality rate, classifying the patient into one of the three severity categories. Our calculator gives you also short instructions on how to treat and take care of patients who have cirrhosis.

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Child-Pugh Score – Definition

In medicine, the Child-Pugh score was first used as an indicator to predict mortality during surgeries. However, today its use has been extended, and people primarily use it for the prognosis of patients with chronic liver disease.

Child-Pugh Score – History

In 1973, CTP (Child-Turcotte-Pugh) was developed and mentioned for the first time. It was used to estimate mortality risk for patients with bleeding esophageal varices. A few decades later, the score was redesigned and modified, and today, in medicine, we use it to control and monitor patients (treatment) with chronic liver disease diagnosis. Some criticized it for its inconsistent scoring that may occur, yet it remained a very widely used tool in medicine. Some of its cons are fixed by introducing a modern The Model for End-Stage Liver Disease, which is used along with the CTP score today.

CTP Formula

The formula for calculating the CTP score is pretty straightforward. There are five parameters:

• Total bilirubin
• Serum albumin
• INR
• Ascites
• Hepatic encephalopathy

And each of them has three given options. Depending on which option you choose, you will get between 1-3 points. Of course, the more points you collect, the higher severity will be.

CTP Score – Interpretation

When you calculate the CTP score for an individual, you can see which category an individual belongs to. Generally, there are three categories: A, B, and C. Category A represents the least dangerous form, whereas category C indicates that an individual has the worst form of cirrhosis.

In the table below, you can find out what’s the survival rate for each category:

Points	Class	Description	One-year survival	Two-year survival
5-6	A	well-functioning liver	85%	85%
7-9	B	significant functional compromise	80%	60%
10-15	C	decompensation of the liver	45%	5%

Child-Pugh Classification – Table

Parameter	1	2	3
Ascites	None	Mild (or supressed with medication)	Severe (or refractory to treatment)
Total Bilirubin	<2 mg/dL (<34.2 micromol/L)	2 to 3 mg/dL (34.2 to 51.3 micromol/L)	>3 mg/dL (>51.3 micromol/L)
Albumin	3.5 g/dL (35 g/L)	2.8 to 3.5 g/dL (28 to 35 g/L)	<2.8 g/dL (<28 g/L)
INR	<1.7	1.7 to 2.3	>2.3
Encephalopathy	None	Grade 1 to 2	Grade 3 to 4

Child-Pugh vs. Model for End-Stage Liver Disease

We already said that MELD was introduced as an extension to the CTP score. The CTP score was useful and fairly effective in the prognosis of a patient with liver diseases, but it has flaws. Consequently MELD was developed in 2001, and people often use it in conjunction with the CTP score.

By definition, the Model for End-Stage Liver Disease predicts the mortality risk and case urgency (treatment) for patients with liver disease. Additionally, it tells us how soon a patient needs a liver transplant.

If compared to the CTP score, the Model for End-Stage Liver Disease score used only three parameters for calculations:

• Total Bilirubin
• International Normalized Ratio (INR)
• Creatinine

Score interpretation for MELD:

• >= 25 (deadly state of a patient)
• 24 to 19
• 18 to 11
• <= 10 (normal state of a patient)

Child-Pugh Score and Cirrhosis

We mentioned that the CTP monitors the clinical state of patients suffering from liver diseases. One of them is cirrhosis, the most dangerous. It is the late stage of liver scarring due to many liver diseases and conditions. However, it is not a disease but a state caused by other diseases.

What does cause it:

• viral hepatitis – hepatitis B and C
• alcohol-induced liver disease
• non-alcoholic steatohepatitis
• primary biliary cholangitis
• primary sclerosing cholangitis
• autoimmune hepatitis
• metabolic disorders, like Wilson’s disease or hemochromatosis
• inherited disorders of sugar metabolism
• infection, such as syphilis or brucellosis

Child Pugh Calculator – How to Calculate?

Let’s see how we can use our calculator for assessing a patient with cirrhosis.

Note: You need to go through 5 parameters and select one of the given three options for a particular parameter, respectively.

1. Bilirubin: Measure a patient’s bilirubin and choose the option according to that. 
2. Albumin: Choose the correct range based on the value you get from the last patient’s measurement.
3. INR: Select the INR range.
4. Ascites: Choose “None”, “Mild” or “Severe”.
5. Encephalopathy: Choose “None”, “Grade I or II”, “Grade III or IV”.

Further, the calculator will collect all the information and calculate the total score. As a result, our calculator will display which category the patient belongs to, A, B, or C, based on the score.

Child Pugh Calculator – Example

It’s time for a practical example. So let’s make up a scenario and show you practically how our calculator does the job.

Scenario: You want to check the state of a patient suffering from liver diseases using the calculator.

Steps:

• We measure the bilirubin of the patient, and for example, we choose “2-3 mg/dL”
• The serum of the patient is greater than 3.5 g/dL
• International Normalized Ratio is between 1.7 and 2.3
• By subjective assessment, we found out the patient has mild ascites
• And there is no hepatic encephalopathy
• The calculator shows us the CTP for the patient, which is 8
• Additionally, how dangerous the state is and you will get instructions on what to do with the patient.

FAQ